Whooping cough in WA

[SweetSilver]

I wasn't sure which forum to put this under, since it's not necessarily a question to decide whether to vax or not, but.... well, you'll read it.

What could be causing this "epidemic" (official words) of whooping cough in WA?  The official line is unvaccinated individuals, adults as well as children.  Apparently, the highest rates (numbers?) since the '40's.  A high school close for sanitizing (flu and whooping cough) and the news is filled with important people urging adults to get vaccinated.

Is this the entire story?  That WA has high rates of unvaccinated individuals?  That adults need to continue vaccinating for pertussis?  How do we compare to other states?

I just don't even know where to begin.  I don't even know why I want the answers to this, but here it is.  I would like some information to consider, but I'm not sure the best place to get it.  

[nukuspot]

subbing.  I have theories and such but I have to get ready for bedtime so I want to read what others write before I can get back on...

[Belkin]

Refusers here from Bainbridge Island WA. Two recent stories to add to the WA state pertussis hysteria outbreak.

1) The WA state Governor and health department are pushing their 'cocooning' pertussis vaccine program. The same program was just cancelled in Australia because it is 'clinically ineffective' according to drug company scientists. Read more here: http://therefusers.com/refusers-newsroom/australia-cancels-pertussis-vaccine-program-because-it-is-clinically-ineffective/

WA state is making a fool of itself by pushing a non-scientific vaccination program.

2) Here's the most amusing recent quote from a news story on the ineffective vaccine topic from a WA health official: 'Sandi Paciotti, the Communicable Disease Manager for the Skagit County Health Department ... said typically 15 out of 100 people immunized are vulnerable to contracting pertussis,  but she's finding 80 to 90 percent of the cases she investigates involve people whose immunizations should be current.' http://www.nwcn.com/home/?fId=150666765&fPath=/news/local&fDomain=10212

Have you had all your shots? Have you had all your shots? Your papers please your papers please, have you had all your shots? Vaccine Gestapo by the Refusers (my band) listen here: http://www.reverbnation.com/play_now/song_10969778

[briannas auntie]

Is that whooping cough vaccine for adults safe?  I have a 3 year old niece that is living with me right now and I am worried about her getting whooping cough, but since reading "The Vaccine Book" by Dr. Sears, I am a bit nervous to get vaccinations for her and me.

[Taximom5]

Brianna's auntie, it depends on whom you ask. If you ask people who have had the vaccine and did NOT have any adverse reaction, they'll tell you it's safe.

If you ask people who had the vaccine and had a severe adverse reaction, they'll tell you it's not safe.

Be aware that there is no single "Pertussis Vaccine.". The vaccines available combine pertussis with either diphtheria, tetanus, or both. If you have had a tetanus booster in the last 5-10 years, you very likely were given a DTaP (diphtheria, tetanus, and acellular pertussis) shot.

Also be aware that your getting vaccinated for pertussis may not prevent you from getting pertussis, as pertussis has mutated. It also will not prevent you from spreading pertussis to your neice.

[nukuspot]

Brianna's Auntie, I agree with everything Taximom5 wrote.  I also want to say that the main risk of major morbidity and mortality from pertussis is almost 100% in infants, most less than 4 months of age.  For a 3 year old, even though having pertussis would be pretty horrible, she is likely to be just fine.  I say this as a mother of a non-vaxxed 3 y/o myself.  My main concern is for my newborn who will be born in September.  So if you want to get yourself a Tdap booster it makes sense, since you are a consenting adult who probably would do fine with it.  But do I think there is no urgency to vaccinate a toddler in this case if the toddler is not going to be around infants.

Belkin,

I still don't see anything in that Australian article that tells me anything more than "It didn't work so we discontinued the policy".  I wish there was a link to the actual findings of the investigative committee.  Even if a random committee in Australia found for some unspecified reason cocooning didn't work on a public health scale, it still makes sense to this mama. 

Now seriously, I am not arguing that cocooning makes sense on a pro-vax standpoint here.  Let me be clear.  I don't vaccinate my daughter at this point in her life.  I have thought about it (especially recently) and still don't see a favorable risk/benefit ratio.  But I am not against vaccination full stop.  I just question the safety, especially in children.  That said, when I weigh the pros and cons of cocooning vs not cocooning it still seems like the sensible option for me and also for others.  I don't worry much about my DH getting a vaccine reaction since he is full grown with no history of health issues.  (As a matter of fact I just got him to get Tdap since we will be doing cocooning--I am immune myself from actually having pertussis 4 years ago, I got my titer checked.)  I also don't see any reason for the rest of our adult immediate family (grandparents) to get the Tdap before coming to visit the newborn.  If the alternative is to do nothing, why not be proactive (for consenting adults who are willing and happy to get Tdap to get it)?  And I am speaking for my own family here, but I do see it as a microcosim of a whole.  I don't see why cocooning should be discouraged on this forum and elsewhere?

Even if my version of cocooning is not totally without holes (since my toddler is un-vaxxed) it seems sensible to try as hard as I can to prevent adults from getting pertussis and bringing it into the home.  The CDC MMWR from 2008 says that computer models showed a newborn has a 38% less chance of catching pertussis if both parents are vaxxed.  And the numbers go up to 75% if all family members coming in contact with the new baby are vaxxed with Tdap.  Even though the vaccine is ineffective (and we all know it is, I am not disputing that), it still can make the vaxxed person have a less severe case, and less coughing =less transmission opportunity for the bacteria.  So in that, I do think it is effective.

Where it gets murky is that I don't necessarily agree with kids getting vax pushed on them by the state.  So the part of cocooning that our state (WA) is currently implementing with doing boosters in middle and high schools kind of freaks me out.  I mean, parents do have a right to decline the vax for their kids in this state, but it seems too much like forced vaccination in that case.  However, I am all for a consenting adult (or older child) willingly walking into a pharmacy or Dr. office and requesting a booster because of cocooning...

[nukuspot]

Also, Brianna's Auntie,  you never said if the niece had ever been vaccinated with Dtap?  Because if she had gotten 4 shots (which is standard up to this point for a 3 y/o) she would be considered "up to date" on her vaccines and not need a booster at this time anyway.

[SweetSilver]

Please explain the "cocooning" that the governor is recommending.

[member234098]

C

Edited by member234098 - 5/25/12 at 5:07pm

[purslaine]

Originally Posted by nukuspot 

  Even though the vaccine is ineffective (and we all know it is, I am not disputing that), it still can make the vaxxed person have a less severe case, and less coughing =less transmission opportunity for the bacteria.  So in that, I do think it is effective.

I am not sure that is the case with immediate family members.  Pertussis is highly contagious, and I imagine even a mild case would be transmitted to individuals living in the same household.  

I do think less severe cases offer some protection to the community at large…less coughing= less transmission, just not to family members due to proximity and repeated exposure.

As per cocooning - if you are worried about your baby getting pertussis and that worry stems from actual statistics (which it seems like it does in your community), go for the vax.   Simply because it is not effective en masse does not mean it will be ineffective in your household.  If you intend to stay home with the baby, and perhaps limit hanging out in play groups and such until your baby is older or until pertussis is contained  in your community, it might help lower the chance of baby getting pertussis.

I do not vax, btw.  I am not 100% anti-vaccine, though….in some circumstances for some people, certain vaccines may be the way to go.

[purslaine]

Originally Posted by nukuspot 

 I don't worry much about my DH getting a vaccine reaction since he is full grown with no history of health issues.  (As a matter of fact I just got him to get Tdap since we will be doing cocooning--I am immune myself from actually having pertussis 4 years ago, I got my titer checked.)  I also don't see any reason for the rest of our adult immediate family (grandparents) to get the Tdap before coming to visit the newborn.  If the 

nukuspot…..and other pregnant lurkers….

If you are breastfeeding, will you pass on your immunity to pertussis through your breastmilk?  I know this is not an infallible method (BFing to pass on immunity - my BF daughter got chicken pox dispute my immunity to it years ago)  but it might be worth exploring how likely an infant who is BF (when the mother has immunity to the disease ) is to get the disease.

[slmommy]

Originally Posted by kathymuggle 

nukuspot…..and other pregnant lurkers….

If you are breastfeeding, will you pass on your immunity to pertussis through your breastmilk?  I know this is not an infallible method (BFing to pass on immunity - my BF daughter got chicken pox dispute my immunity to it years ago)  but it might be worth exploring how likely an infant who is BF (when the mother has immunity to the disease ) is to get the disease.

They should pass antibodies transplacentally too if they have had pertussis or are still covered by previous vax. Sounds like this also possibly could "blunt" the efficacy of the first infant DTaP.... and they also have a section about cocooning here too, albeit from 2011:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm

Quote:

For infants, transplacentally transferred maternal antibodies might provide protection against pertussis in early life and before beginning the primary DTaP series. Several studies provide evidence supporting the existence of efficient transplacental transfer of pertussis antibodies ...

 

The half-life of transferred maternal pertussis antibodies is approximately 6 weeks (12). The effectiveness of maternal antipertussis antibodies in preventing infant pertussis is not yet known, but pertussis-specific antibodies likely confer protection and modify the severity of pertussis illness...

 

To optimize the concentration of maternal antibodies transferred to the fetus, ACIP concluded that unvaccinated pregnant women should receive Tdap, preferably in the third or late second (after 20 weeks gestation) trimester.

[nukuspot]

In the CDC MMWR (2008) they state that antibodies to pertussis do not pass through the breastmilk in humans in amounts large enough to elicit an immune response in infants.  However they do in other mammals.  It's one of the many strange things about pertussis...So I don't think we can count on our BM to protect our infants for this one thing, though of course it is perfect for giving antibodies to many other diseases.

Kathymuggle, I feel the same way as you do about vaccinations.  I don't vaccinate at the moment, but I don't necessarily see vaccines as evil either.  I think there is a huge risk/benefit ratio that every person needs to look at and see what is right for them and their family.  I think there are real risks and real benefits for doing either side.  So for cocooning we are doing I guess a partial cocoon.  We will vax the adults in contact with baby, but have decided to not vax our 3 year old, as I think the risk/benefit ratio is not favorable, at the best equivocal for her.  We have already decided that the newborn will be staying at home for the first few months of life.  Parents will take turns bringing our toddler to preschool, friend's homes, go food shopping, etc.  We will not host playgroups at our home.  As for our toddler's exposure we have a really nice group of friends with kids her age.  Most are vaxxed except her best friend.  I know all these parents and most of them are great at not bringing kids to playgroups when they are sick, even a cold.  The only wild card as I see it is her preschool.  There will be 5 other kids in her class.  One is her (unvaxxed) best friend, but I know her mom won't send her to school if she is ill.  The 4 other children I have no idea about.  I have never met their families yet.  So there will be 4 wild cards but I think the risk should be low enough that it shouldn't be a major weak point in our cocooning strategy. 

At best I am trying as much as I can to plan for something I can't control.  It sometimes gets me stressed but now that I made the decision I am trying to just go with it and not second guess myself.

[nukuspot]

PS, thanks for posting the update to the MMWR.  I only have the one from 2008.

[Bokonon]

Nukuspot, I just want to give you a big hug and let you know that I truly admire how much research and thought you've given to this very difficult decision. 

[SweetSilver]

So, is pertussis mainly transmitted through coughing?  Would you be able to see a sick friend (or friend of friend) and avoid contact and be able to successfully avoid transmission (mostly)?  Or is it similar to the way chicken pox is transmitted--often highly contagious even before obvious symptoms?

[nukuspot]

Bokonon--Thank you so much.  It's been a crazy journey.  I'm trained as a midwife.  I have a background in health care and I know how to find and read research.  Before my DD1 was born I read everything under the sun and was 100% solid in my choice to not vaccinate her.  These last few years of being a mama have taught me a lot.  I'm no longer as 100% about ANYTHING anymore.  And I do think my spirit has been a bit beaten down by having to constantly explain my choice to not vaccinate to doctors (her pediatrician has been actually really great to us, but it's the other doctors in the practice as well as ER doctors who I am referring to) as well as to some of my family members (my father especially.)  And then there are my parenting friends...I guess I thought that all the attachment parenting, extended breastfeeding, cosleeping mamas out there I knew would understand about my reluctance to vaccinate.  But you know what?  They don't.  I wouldn't say they were mean about it, it's just that they don't understand why I would make that choice.  So all that doubt kind of got under my skin.   I'm not anti-vaccine.  Not at all.  It just wasn't a choice that felt right now my family.  I guess in the back of my mind I thought I'd reevaluate my decisions when an epidemic came around.  Or when she was old enough to start school...And now here we are...But in the end my decision about what is right for my DD still remains the same.  I had an appointment made for her to get her first DTaP.  And I couldn't sleep.  I was a zombie.  It felt so wrong to me for so many reasons.  The day I cancelled it I could sleep again.  That doesn't mean I am all happy and footloose about my decision.  But I do need to follow my instincts.  And right now, even if it is ultimately the "wrong" decision to keep her un-vaxxed, it feels like the right one.  My brain and soul hurt from research.  I need to just move on and get back to enjoying life and playing with my child again instead of sitting in front of the computer reading article after article.

SweetSilver--it is transmitted by droplet form, so coughing, sneezing would be the main routes of transmission. 

I don't bring my daughter to see a sick friend.  Even before pertussis I wouldn't have.  Her friends (and our adult friends) have been great over the last years about not coming to parties, playgroups, etc when they are sick.  I likewise don't bring my daughter out in public when she is sick, even a runny nose.  I actually (even before the epidemic here in WA) have always brought her to the pediatrician when she had a bad cough.  She's gotten 2 pertussis nasal swabs in her life (just to r/o pertussis) because I feel that because I chose to not vaccinate her, I need to make sure she does not have pertussis early if she gets a coughing illness so she can't spread it before it is diagnosed.  If she did I would for sure give her the antibiotics and take them myself, in order to not risk spreading the disease.  I've always seen my choice to not vaccinate my child as a privledge, one that I am thankful to be able to have, but I don't want to take for granted.   Now there are always the variables, such as going food shopping, to the park, etc.  But I never wanted my choice to not vaccinate to cause me to live in a bubble either, so we try to live our lives as normal.  With the exception of the first few months of the new baby's life (where we will be doing cocooning) I can imagine things will not change much as far as where we go or what we will do with the kids.

[nukuspot]

Also SweetSilver,

You asked in your OP about why officials think pertussis is spreading.  Here is what the spokesperson from the CDC says: 

Patti (CDC spokesperson) emphasized that pertussis isn’t spreading because of an anti-vaccine movement. Among possible reasons for the recent spike are that diagnoses in teens and adults are getting better and doctors are doing a better job with reporting, she added.

Health officials say the disease tends to return in three-to-five-year cycles.

“The incidents tend to oscillate,” said Herbert Hethcote, a professor emeritus from the University of Iowa who is a specialist in mathematical modeling of the spread of infectious diseases.

He said the growth of pertussis in Washington has followed a pattern: As the population ages, the immunity level goes down because the vaccine is wearing off. The disease spreads and the cases grow until more people get the vaccine and the numbers go down again.

From http://www.thenewstribune.com/2012/05/11/2139671/whooping-cough-spikes-in-state.html

Read more here: http://www.thenewstribune.com/2012/05/11/2139671/whooping-cough-spikes-in-state.html#storylink=cpy

[SweetSilver]

Thanks for the link. 

[Turquesa]

Originally Posted by Belkin 


WA state is making a fool of itself by pushing a non-scientific vaccination program.

2) Here's the most amusing recent quote from a news story on the ineffective vaccine topic from a WA health official: 'Sandi Paciotti, the Communicable Disease Manager for the Skagit County Health Department ... said typically 15 out of 100 people immunized are vulnerable to contracting pertussis,  but she's finding 80 to 90 percent of the cases she investigates involve people whose immunizations should be current.' http://www.nwcn.com/home/?fId=150666765&fPath=/news/local&fDomain=10212

Interesting!! Thanks for sharing.

This should get interesting. Public health officials depend on our trust, so expect them to be resistant to admitting that they were wrong....